Prognostic Factors in Syphilitic Uveitis

• Published in: Ophthalmology (Rochester, Minn.) Vol. 124; no. 12; pp. 1808 - 1816
• Main Authors: Hoogewoud, Florence, Frumholtz, Laure, Loubet, Paul, Charlier, Caroline, Blanche, Philippe, Lebeaux, David, Benhaddou, Nadjet, Sedira, Neila, Coutte, Laetitia, Vanhaecke, Clelia, Launay, Odile, Le Jeunne, Claire, Héron, Emmanuel, Monnet, Dominique, Lortholary, Olivier, Sahel, José-Alain, Dupin, Nicolas, Brézin, Antoine, Errera, Marie-Hélène, Salah, Sawsen, Groh, Matthieu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2017
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Azithromycin - therapeutic use; Doxycycline - therapeutic use; Eye Infections, Bacterial - diagnosis; Eye Infections, Bacterial - drug therapy; Eye Infections, Bacterial - microbiology; Female; Fluorescent Treponemal Antibody-Absorption Test; Follow-Up Studies; HIV Seropositivity; Humans; Male; Middle Aged; Penicillin G Benzathine - therapeutic use; Polymerase Chain Reaction; Prognosis; Retrospective Studies; Sulfadiazine - therapeutic use; Syphilis - diagnosis; Syphilis - drug therapy; Syphilis - microbiology; Syphilis Serodiagnosis; Uveitis - diagnosis; Uveitis - drug therapy; Uveitis - microbiology; Visual Acuity - physiology; VDRL; cRR; STD; SU; OR; ARV; CI; MSM; IV; SUN; TPHA; BCVA; HIV; CSF; BPG
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2017.06.003

To identify predictors of treatment success in syphilitic uveitis (SU). Retrospective multicentric analysis of patients treated for SU. A total of 95 eyes (66 patients, mean [standard deviation] aged 49 [12.5] years, 31 [47%] of whom were human immunodeficiency virus [HIV]+) were analyzed. Activity of SU was assessed at 1 week and 1 month after treatment onset, and at last follow-up. Improvement was defined by a ≥2-step decrease of both anterior chamber and vitreous haze inflammation levels, and by the size reduction in chorioretinal lesions. Recovery was defined as the resolution of inflammation in all anatomic structures at 1 month. Panuveitis and posterior uveitis were the most frequent findings. Inflammatory parameters were higher in HIV+ patients. Recovery was reported in 65% and 85% of eyes at 1 month and at last follow-up, respectively. In multivariate analysis, after adjusting for initial best-corrected visual acuity and the antimicrobial treatment regimen, clinical improvement at 1 week (corrected risk ratios [cRR], 3.5 [2.3–3.8]; P = 0.001) was predictive of recovery at 1 month, whereas the use of periocular dexamethasone injections (cRR, 0.05 [0.02–0.6]; P = 0.01) and methylprednisolone pulses negatively affected the outcomes of eyes. Early improvement is the strongest predictor of ophthalmological recovery in SU.